John Bailar, biostatistician who redirected U.S. cancer policy, 1932-2016

A renowned biostatistician and epidemiologist who used those tools to study cancer risk, prevention and treatment and the impact of environmental exposures on health, John C. Bailar, III, MD, PhD, professor emeritus in the Department of Public Health Sciences at the University of Chicago, died Sept. 6, in Mitchellville, Maryland. He was 83.

Although Bailar published nearly 300 academic papers, reports and book chapters, he was perhaps best known for two controversial studies. The first, “Progress Against Cancer?” published May 29, 1986, in the New England Journal of Medicine, argued that for 35 years, including the 15 years following Nixon’s 1971 declaration of the “War on Cancer,” the nation’s basic anti-cancer battle plan was fundamentally misguided.

Cancer research focused too much on treatment and not enough on prevention, which would have been far more effective, suggested Bailar and co-author Elaine Smith, PhD, an epidemiologist from the University of Iowa. Death rates for many other illnesses, such as heart disease and stroke, had plummeted. Yet, despite considerable investment in research, death rates from cancer had barely budged. “Years of intense effort focused largely on improving treatment must be judged a qualified failure,” the authors declared.

Their article “sent a deep gash into the National Cancer Institute’s brow,” according to Siddhartha Mukherjee, MD, author of the Emperor of All Maladies, a prize-winning book on the history of cancer research. It “shook the world of oncology by its roots,” he wrote. Vincent DeVita, the head of the National Cancer Institute at the time, described the conclusion as “reprehensible,” and suggested that the authors had “departed from reality.” But no one seriously questioned the data.

Exactly 11 years later, May 29, 1997, Bailar, then at the University of Chicago, working with fourth-year medical student co-author Heather Gornik, published a sequel, “Cancer Undefeated.” Despite collecting more than a decade of additional data and experience, they saw no reason to change the previous finding. “Hopes for a substantial reduction in mortality by the year 2000,” they wrote, “were clearly misplaced.” They renewed the call for more emphasis on prevention and less “blind faith” in treatment. Prevention, they insisted, “is now the way to go.”

This shift in perspective, Mukherjee pointed out, “contributed to the moment at which the war on cancer became a war on smoking.”

Bailar also published and lectured extensively on a wide range of health and statistical topics, from the risks and benefits of screening tests, particularly mammography, to the impact of environmental exposures on health. He even offered guidance for both the media and statisticians on how best to work together.

“John Bailar was a distinguished biostatistician and cancer epidemiologist, with a strong and often controversial voice in aspects of health policy,” said colleague Ronald Thisted, PhD, professor of statistics and public health sciences at the University of Chicago.

He was also a “terrific mentor,” said Gornik, now an associate professor of medicine at Case Western Reserve University School of Medicine, in Cleveland. “He provided a good deal of guidance on our project, but he also gave me a lot of leeway. I spent so much time in the library that year, chasing down raw data on all cancer deaths in the United States for the period we studied.”

“He protected me somewhat from the political fallout,” she said, “but he also gave me a chance to learn how to present provocative results and manage the response. The day the paper came out, there were so many requests for interviews that he sent me, a medical student, to debate the issue on network television, the Bill O’Reilly Factor. It was me versus the head of the cancer program at one of the most revered hospitals in the U.S. I’m told I held up pretty well. I was too naïve to be nervous.”

“The ideal candidate”

John Christian Bailar, III, was born Oct. 9, 1932, in Urbana, Ill. His father, John C. Bailar, Jr., was a well-known chemistry professor at the University of Illinois and a recipient of the Priestley Medal, the highest honor conferred by the American Chemical Society. Bailar initially followed his father’s footsteps, majoring in chemistry, but after earning his degree in 1953 from the University of Colorado, he entered medical school at Yale University.

He graduated in 1955, spent one year as an intern at the University of Colorado, Denver, then dived back into research, joining the United States Public Health Service. He spent much of his early career at the National Cancer Institute (NCI), where he was Editor-in-Chief of the Journal of the National Cancer Institute for six years.

He spent 24 years in government positions. During that period, Bailar returned to school part time and completed a PhD in statistics 1973 at American University, in Washington, DC. He met his wife Barbara there.

In 1980, he moved to Boston where he taught biostatistics at the Harvard School of Public Health and served as a statistical consultant for the New England Journal of Medicine. In 1992, he became a member of the NEJM editorial board.

He also worked part-time with the Environmental Protection Agency and the Department of Health and Human Services. In 1989, he moved to Montreal to teach epidemiology and statistics at McGill University and to perform research at Montreal General Hospital. In 1995, he came to the University of Chicago as a professor and the first chairman of the Department of Health Studies, (now Public Health Sciences), with an additional appointment in the Harris School, of Public Policy.

“He seemed to be the ideal candidate to lead a new department focused on biostatistical methods, epidemiologic investigation, and health services research,” Thisted said. “The department was unique at the time, comprising scholars who neither ran wet labs nor field studies, but rather focused on the analysis and interpretation of population-level data on health and disease.”

Bailar won many honors, including selection as a MacArthur Fellow, from 1990 to 1995, and election in 1990 to the Collegium Ramazzini, an international academy of scientists with leading roles in environmental and occupational health. In 1992 he was elected as a fellow in the American Association for the Advancement of Science and in 1993 he was named to the Institute of Medicine (now the National Academy of Medicine).

He is survived by his widow Barbara, brother Benjamin, and children, Elizabeth, Melissa, John IV, and James; one stepdaughter, Pamela Monaco; and eight grandchildren.

A memorial service is scheduled for 3 p.m. on Sun., Oct. 9, in the Chapel of Collington Retirement Community, 10450 Lottsford Road, Mitchellville, MD.